Provider Demographics
NPI:1538595558
Name:BROWN, ANDRETTA MONIQUE (LMT)
Entity type:Individual
Prefix:MS
First Name:ANDRETTA
Middle Name:MONIQUE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 TOMLINSON CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2933
Mailing Address - Country:US
Mailing Address - Phone:443-994-3458
Mailing Address - Fax:
Practice Address - Street 1:1421 CLARKVIEW RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2133
Practice Address - Country:US
Practice Address - Phone:443-994-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist